The safety, health, and dignity of sanitation workers, despite being critical to global sanitation efforts, have long been neglected. This study addressed this issue by conducting a comprehensive analysis of the occupational safety, health, and dignity of sanitation workers in Mukuru kwa Reuben slums, Nairobi, Kenya. The research objectives included assessing occupational hazards, examining factors associated with the current state of occupational safety, health, and dignity, and evaluating existing measures for worker protection. The study adopted a mixed-methods approach, combining qualitative and quantitative data to provide a holistic understanding of the issues. The findings, n=40, revealed significant occupational hazards faced by sanitation workers, with chemical hazards being the most prevalent (40.0%), followed by psychosocial (27.5%), physical (22.5%), and biological hazards (10.0%). A staggering 85.0% of workers reported a lack of access to personal protective equipment (PPE). Socioeconomic factors strongly influenced workers' conditions, with significant correlations found between the state of occupational safety and health (OSH) and various factors: availability of PPE (r = 0.574, p = 0.002), income (r = 0.613, p = 0.000), poverty (r = -0.491, p = 0.000), and training (r = 0.516, p = 0.004). Environmental factors also showed strong correlations, with occupational hazards negatively impacting OSH (r = -0.725, p = 0.000) and working conditions positively influencing OSH (r = 0.672, p = 0.000). The study uncovered significant deficiencies in occupational safety measures, with 77.5% of workers reporting a lack of standard operating procedures, 87.5% lacking access to welfare facilities, and 72.5% not receiving any training on sanitation work. Social stigma and discrimination affected 67.5% of workers, negatively impacting their dignity. Additionally, 82.5% of workers lacked formal employment contracts, and 85.0% were unaware of any government policies recognizing their work. Based on these findings, the study recommends enhancing training and awareness programs, providing access to PPE, improving working conditions, strengthening legal protections, establishing supportive networks, and conducting regular monitoring and evaluation. This research highlights the urgent need to prioritize the well-being of sanitation workers, recognizing their crucial role in sanitation services and addressing the multifaceted challenges they face.